We had received a referral for a Home Infusion patient that was on IV Flagyl q 8hrs, IV Azactam q 8hrs, and, IV Vancomycin 1.25grams q 12hrs. THe patients' tip was just distal to the subclavian vein at the very top of SVC. I informed referral source and PICC team that PICC needed to be repositioned since tip was in a suboptimal place and that we wouldn't accept patient for home care. The hospital wouldn't reposition PICC and referral was given to another Home Infusion Company. Was my decision correct? I was considering patient safety in regards to my decision. Patient was at high risk for blood clots and not to mention if the PICC backed out 1 cm it would have been out of the central circulation.
Jean Cancelmo, BSN, CRNI
I think your decision was correct. If you accept the patient, you also accept the risk of this tip location, which is great. Wonderful way to get dragged into a lawsuit. Best thing is to do what you did, although I am certain your financial people do not see it this way. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
Looking for references... hospitals that have replaced xray confirmation with tip location systems. Lisa
Providence Sacred Heart Medical Center, Spokane, WA. Dr. Ken Symington, radiologist gave a presentation at AVA on their process and outcomes and have replaced the routine xray when ECG shows a good, consistent, and regular P wave. Lynn
Lynn Hadaway, M.Ed., RN, BC, CRNI
Lynn Hadaway Associates, Inc.
126 Main Street, PO Box 10
Milner, GA 30257
Website http://www.hadawayassociates.com
Office Phone 770-358-7861
thanks. I started looking through my AVA stuff to find his hospital. Lisa
Lisa, regarding your question, the best people to ask are the manufacturers of the two devices with this capability, Bard and Teleflex. Both should be able to give you a list of hospitals that have moved to replace chest x-ray per the FDA guidence with a tip location device. If you would like a lsit from Teleflex, email me directly and I can send to you.
Thanks
Chris Cavanaugh, RN, BSN, CRNI, VA-BC
thanks. I'll email you. Lisa
Hello Jean,
We use Vasonova guidance system from Teleflex now. Previously used ECG guidance with Pacerview and haven't routinely used CXR since 2009. I agree with your decision and feel strongly that the hospital needed to replace the PICC in question. I would be happy to talk with you about ECG guidance since I am familiar with both Sapiens and Vasonova systems. My email address is [email protected].